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Crouse DL, Boudreau J, Leonard PSJ, Pawluk K, McDonald JT. Provider caseload volume and short-term outcomes following colorectal surgeries in New Brunswick: a provincial-level cohort study. Can J Surg 2020. [PMID: 33107818 DOI: 10.1503/cjs.012319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND American studies have shown that higher provider and hospital volumes are associated with reduced risk of mortality following colorectal surgical interventions. Evidence from Canada is limited, and to our knowledge only a single study has considered outcomes other than death. We describe associations between provider surgical volume and all-cause mortality and postoperative complications following colorectal surgical interventions in New Brunswick. METHODS We used hospital discharge abstracts linked to vital statistics, the provincial cancer registry and patient registry data. We considered all admissions for colorectal surgeries from 2007 through 2013. We used logistic regression to identify odds of dying and odds of complications (from any of anastomosis leak, unplanned colostomy, intra-abdominal sepsis or pneumonia) within 30 days of discharge from hospital according to provider volume (i.e., total interventions performed over the preceding 2 years) adjusted for personal, contextual, provider and hospital characteristics. RESULTS Overall, 9170 interventions were performed by 125 providers across 18 hospitals. We found decreased odds of experiencing a complication following colorectal surgery per increment of 10 interventions performed per year (odds ratio 0.94, 95% confidence interval 0.91-0.96). We found no associations with mortality. Associations remained consistent across models restricted to cancer patients or to interventions performed by general surgeons and across models that also considered overall hospital volumes. CONCLUSION Our results suggest that increased caseloads are associated with reduced odds of complications, but not with all-cause mortality, following colorectal surgery in New Brunswick. We also found no evidence of volume having differential effects on outcomes from colon and rectal procedures.
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Affiliation(s)
- Dan L Crouse
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
| | - Jonathan Boudreau
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
| | - Philip S J Leonard
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
| | - Keith Pawluk
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
| | - James T McDonald
- From the Department of Sociology, University of New Brunswick, Fredericton, N.B. (Crouse); the New Brunswick Institute for Research, Data and Training, University of New Brunswick, Fredericton, N.B. (Crouse, Boudreau, Leonard, McDonald); the Department of Economics, University of New Brunswick, Fredericton, N.B. (Leonard, McDonald); and the Faculty of Medicine, Dalhousie University, Halifax, N.S. (Pawluk)
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Pawluk K, Booth SE, Coleman NJ, Nicholson JW. The interaction of zinc oxide-based dental cements with aqueous solutions of potassium fluoride. J Mater Sci Mater Med 2008; 19:3035-3039. [PMID: 18389342 DOI: 10.1007/s10856-008-3443-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Accepted: 03/19/2008] [Indexed: 05/26/2023]
Abstract
The ability of zinc oxide-based dental cements (zinc phosphate and zinc polycarboxylate) to take up fluoride from aqueous solution has been studied. Only zinc phosphate cement was found to take up any measurable fluoride after 5 h exposure to the solutions. The zinc oxide filler of the zinc phosphate also failed to take up fluoride from solution. The key interaction for this uptake was thus shown to involve the phosphate groups of the set cement. However, whether this took the form of phosphate/fluoride exchange, or the formation of oxyfluoro-phosphate groups was not clear. Fluoride uptake followed radicaltime kinetics for about 2 h in some cases, but was generally better modelled by the Elovich equation, dq(t)/dt = alpha exp(-betaq(t)). Values for alpha varied from 3.80 to 2.48 x 10(4), and for beta from 7.19 x 10(-3) to 0.1946, though only beta showed any sort of trend, becoming smaller with increasing fluoride concentration. Fluoride was released from the zinc phosphate cements in processes that were diffusion based up to M(t)/M(infinity) of about 0.4. No further release occurred when specimens were placed in fresh volumes of deionised water. Only a fraction of the fluoride taken up was re-released, demonstrating that most of the fluoride taken up becomes irreversibly bound within the cement.
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Affiliation(s)
- K Pawluk
- Department of Environmental, Chemical and Pharmaceutical Sciences, School of Science, University of Greenwich, Medway Campus, Chatham, Kent ME4 4TB, UK
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